Reducing Metabolic Syndrome (MetS) and Unmet Needs Among Rural Breast-Cancer Survivors (BCS) During the Survivorship Transition

Metabolic syndrome (MetS) is a leading risk factor for cardiovascular disease (CVD) related death among breast cancer survivors (BCS). Maintaining a healthy body weight by being physically active and eating a healthy diet are the best means of reducing MetS, yet few program exist to address those factors among rural BCS. Even fewer programs targeted MetS reduction during the initial survivorship transition, a time when many women confront the effects of cancer and its treatment on physical and emotional health and doing so as medical and social supports diminish and unmet needs remain high. Utilizing evidence based habit development strategies to foster healthful dietary and physical activity habit formation in combination with occupational therapy (OT) intervention could reduce CVD risk factors and address physical and psychosocial unmet needs among rural BCS. The purpose of the proposed study is to determine the feasibility and preliminary effects of a manualized, theory based, OT delivered, preventative intervention to foster the formation of dietary and physical activity habits, and reduce MetS and unmet needs among rural BCS ages 40 and older. The specific aims are to (1) determine the feasibility and acceptability of the intervention for rural BCS, and (2) determine preliminary effects of the intervention on the primary behavioral outcome of habit development and the primary clinical outcome of MetS as well as the secondary outcomes of improved dietary quality, physical activity engagement, self-reported unmet needs, and HRQoL. We pursued those aims using a pilot 2-arm randomized controlled trial in which 48 community-dwelling rural BCS will be randomly assigned to receive either the intervention or enhanced usual care. The 22-week intervention consists of three home-based consultations with the OT, 10 biweekly habit tele-coaching sessions, and the use of implementation intentions, micro-environmental modifications, and tailored text messages to support physical activity and dietary habit formation and address unmet needs. Data to support feasibility metrics and primary and secondary outcomes will be collected at baseline and post intervention (week 25) and include measures of: habit development, MetS, dietary quality, physical activity engagement, self-reported unmet needs, and HRQoL. We will report data and findings about intervention feasibility, participant satisfaction, gains in habit development, and changes in MetS factors among BCS when compared with usual care. This is one of the first studies of its kind to combine occupational therapy and behavioral sciences approaches to improve upstream risk factors among at-risk rural BCS. Results of the study provide preliminary insights into the feasibility of an OT led approach and can help inform practice as well as the design of future, larger trials.

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